Gastritis Research Articles

A deep learning based framework for the classification of multi- class capsule gastroscope image in gastroenterologic diagnosis.

Purpose: The purpose of this paper is to develop a method to automatic classify capsule gastroscope image into three categories to prevent high-risk factors for carcinogenesis, such as atrophic gastritis (AG). The purpose of this research work is to develop a deep learning framework based on transfer learning to classify capsule gastroscope image into three categories: normal gastroscopic image, chronic erosive gastritis images, and ulcer gastric image. Method: In this research work, we proposed deep learning framework based on transfer learning to classify capsule gastroscope image into three categories: normal gastroscopic image, chronic erosive gastritis images, and ulcer gastric image. We used VGG- 16, ResNet-50, and Inception V3 pre-trained models, fine-tuned them and adjust hyperparameters according to our classification problem. Results: A dataset containing 380 images was collected for each capsule gastroscope image category, and divided into training set and test set in a ratio of 70%, and 30% respectively, and then based on the dataset, three methods, including as VGG- 16, ResNet-50, and Inception v3 are used. We achieved highest accuracy of 94.80% by using VGG- 16 to diagnose and classify capsule gastroscopic images into three categories: normal gastroscopic image, chronic erosive gastritis images, and ulcer gastric image. Our proposed approach classified capsule gastroscope image with respectable specificity and accuracy. Conclusion: The primary technique and industry standard for diagnosing and treating numerous stomach problems is gastroscopy. Capsule gastroscope is a new screening tool for gastric diseases. However, a number of elements, including image quality of capsule endoscopy, the doctors' experience and fatigue, limit its effectiveness. Early identification is necessary for high-risk factors for carcinogenesis, such as atrophic gastritis (AG). Our suggested framework will help prevent incorrect diagnoses brought on by low image quality, individual experience, and inadequate gastroscopy inspection coverage, among other factors. As a result, the suggested approach will raise the standard of gastroscopy. Deep learning has great potential in gastritis image classification for assisting with achieving accurate diagnoses after endoscopic procedures.

Antioxidant and antimicrobial activity of Tamarix ramosissima halophyte and its application in the food industry

Tamarix ramosissima is a halophytic species with diuretic, diaphoretic, astringent, analgesic and hemostatic effects. Decoctions and infusions used for various diseases are prepared from it. Infusion of flowers is useful for stomach inflammation, decoction of branches is effective for rheumatism, infusion of leaves and bark is prescribed for diarrhea, bleeding and diseases of the spleen. Tamarix twigs are brewed like tea. In the past, a decoction of the fruits of the plant was used in the Caucasus against infertility, and a decoction of branches treated syphilis. In this work, we investigated the antioxidant and antimicrobial activity of Tamarix ramosissima inflorescence extracts as an additive in the food industry. The results showed that the inflorescences exhibit high antioxidant activity, the degree of inhibition at 20 µl of the studied material is 9 times greater. compared with ascorbic acid and 3 times compared with emoxypine. In addition, tamarisk extracts have shown noticeable antibacterial properties against the Staphylococcus aureus strain. The strongest activity was recorded in 70% of the water-alcohol extract of inflorescences at a minimum concentration of 1 to 10. These data indicate that tamarix can be considered as an interesting source of antioxidants for the therapeutic or nutraceutical industry and for food production. These indicators characterize tamarisk extracts as an object for further study, and without a doubt are promising and little-studied raw materials for the food industry

Analysis of Patients With Acute Upper Gastrointestinal System Hemorrhage Applying to Kahramanmaras Sutcu Imam University Medical Faculty Emergency Department

AbstractObjective: Gastrointestinal system bleeding is a health problem with a high life-threatening potential that is frequently encountered in emergency departments in hospitals. This study was planned to determine the etiologic causes, clinical findings, endoscopic findings, and prognosis in patients admitted to our emergency department and diagnosed with upper gastrointestinal system bleeding.Material and Methods: The files of the patients admitted to emergency department due to upper gastrointestinal system bleeding were retrospectively reviewed. Demographic data, clinical characteristics, etiological causes, laboratory and endoscopic results of 31 patients were reviewed. In statistical evaluation, Student t test, One way ANOVA test and SPSS 20.0 package program was used. p<0.05 was considered statistically significant.Results: Hematemesis was the most common reason for admission. As a result of the endoscopic procedure performed on the patients, erosive gastritis was found most frequently. 16.1% of the patients underwent sclerotherapy, and other patients underwent medical treatment. 83.9% of the patients were discharged, however, 16.1% of them died.Conclusion: Analgesics of the non-steroidal anti-inflammatory drugs group and the drugs of the antiaggregant group play a significant role in upper gastrointestinal system bleeding. The drug use should be carefully investigated especially in the elderly population with a history of comorbidities, and the possibility of gastrointestinal system bleeding should not be forgotten while prescribing analgesics. Mortality is high in patients with upper gastrointestinal system bleeding, the treatment should be initiated quickly, and endoscopy should be planned as soon as possible.

PSAT042 Adrenal Insufficiency Associated to Immune Checkpoint Inhibitors

Abstract Background Innovations in management of multiple malignancies have developed throughout the years. Despite benefits in immune checkpoint inhibitors there is an incidence of approximately 9.4% to 10.4% in endocrine immune related disorders. The challenge advocates to promptly recognize the clinical manifestations related to adverse effects. Clinical Case We report a case of a 61-year-old caucasian woman with Metastatic Lung Squamous Cell Carcinoma Stage IV on immunotherapy and radiotherapy who presented to ED with nausea and vomiting for the last 2 weeks. The review of the system pertinent for weight loss 18 pounds in the last 2 months, fatigue and decreased appetite. Medication history pertinent for active Pembrolizumab (started 6 months prior to presentation; cycle every 3 weeks); Radiotherapy (3 cycles) and steroid injections (last dose 1 month prior for bilateral knee pain). Upon arrival vital signs T 36.9C, HR 110/min, RR 18/min, BP 80/60mmHg, and StO2 98%. The physical examination pertinent for an acutely ill patient with tachycardia. Initial laboratory studies showed peripheral eosinophilia 14% (n <6%); high anion gap metabolic acidosis (AG 18), hypokalemia 2.8 mmol/L (n 3.5-5.0mmol/L). The patient was hospitalized with sepsis and intractable vomiting. Gastroenterology evaluated with EGD showed erosive gastritis and reflux esophagitis. CT abdomen with IV contrast showed numerous sclerotic bone lesions and single hepatic lesion suggestive of metastatic disease; unremarkable adrenal glands. Poor response to initial hydration and antibiotics as blood pressure remained fluctuant borderline low prompted evaluation. Random cortisol at 6: 50am showed hypocortisolism (1.6mcg/dl) and TSH 1.290 mcIU/mL (n 0.358- 3.74mcIU/mL); patient was started on stress dose steroids and endocrinology was consulted for suspected adrenal insufficiency. Cosyntropin stimulation test (n >18 mcg/dL) with baseline cortisol levels 1.6mcg/dl and ACTH less than 5mcg/dl; cortisol levels at 30 minutes after 250 mcg of Cosyntropin was 4.3mcg/dl and at 1 hour 6.8mcg/dl, confirming most likely secondary vs primary adrenal insufficiency. Within 24-48 hour stress dose steroids were weaned and the patient was then discharged home with hydrocortisone 20 mg am and 10mg pm for further outpatient management. Conclusion Pembrolizumab is a human programmed death receptor-1-blocking antibody that on October 2015 was FDA approved for treatment of non-small cell lung cancer. Adrenal Insufficiency can cause a broad nonspecific clinical scenario with reported incidence of 0.6-0.7% pembrolizumab-induced AI. This rare clinical entity adrenal insufficiency immune mediated endocrinopathy by pembrolizumab constitutes an emergency that prompts attention for early identification and initial management. Nevertheless increased morbidity and mortality is associated with acute adrenal crisis encouraging physicians to be aware of this particular risk. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Erocive gastritis with bipolar affective disorder current episode severe depression with psychotic symptoms with history of sexual violence in adolescent

Depression is a mental health disorder characterized by feelings of sadness, unhappiness, hopelessness, and even guilt. Erosive gastritis is an erosion of the gastric mucosa caused by damage to the mucosal barrier that is superficial but does not penetrate the muscularis mucosal layer. The patient is a 17 year old girl. Experiencing sad behavior changes, lack of interest, loss of joy, and suicide attempts. In addition, the patient was vomiting blood, and was examined by a pediatric gastroenterohepatologist. The supporting examination that was carried out, namely endoscopy, showed that the patient had erosive gastritis. The patient was consulted to the psychiatry department because there was a history of psychiatric treatment due to a history of depression. The treatment provided includes psychoeducation, administration of antipsychotic drugs quetiapine and valproic acid, as well as drugs for erosive gastritis including Sucralfate and Omeprazole. Episodes of major depression with psychotic symptoms can cause erosive gastritis in adolescents. Stress affects physiological effects, via the HPA-axis pathway.

S2517 Pill Prep Problems? Erosive Gastritis and Peptic Ulcers due to Sodium Sulfate-Based Tablet Bowel Prep

Introduction: SUTAB is the second ever tablet formulation for bowel preparation. It became FDA approved in 2020 based on 2 randomized studies in which SUTAB provided noninferior bowel cleansing when compared to other commonly used FDA approved preparations. These randomized studies focused only on colonoscopies, possibly ignoring SUTAB’s effects on the upper GI tract. Endoscopists have recently been noticing significant adverse side effects from SUTAB, notably erosive gastritis and peptic ulcers in patients scheduled for same day bidirectional endoscopy. These findings were not noted by the studies used for FDA approval. SUTAB is a sodium sulfate based tablet composed of 3 main active ingredients: sodium sulfate, magnesium sulfate, and potassium chloride. SUTAB is taken as a 2-day split dose regimen of 24 tablets with large volumes of water. The most common adverse side effects published for SUTAB include nausea, abdominal distension, vomiting, and abdominal discomfort. Any mention of mucosal ulcerations focused on colonic ulcerations in patients with suspected inflammatory bowel disease or in concurrence with the use of stimulant laxatives. Case Description/Methods: 5 cases of same day bidirectional endoscopy were examined from 9/2/2021 to 11/15/2021. Indications for upper endoscopy included a history of Barrett’s esophagus and/or gastroesophageal acid reflux disease and all patients used SUTAB as the sole bowel preparation. In all cases there was no previous history of erosive gastritis or peptic ulcer disease, however, all upper endoscopies noted signs of moderate to severe erosive gastritis. Two of the cases also noted similarly appearing linear gastric ulcers with black eschars. All patients were subsequently placed on antacid therapy and follow-up endoscopies were performed to assess ulcer healing, which was noted at the time. Discussion: SUTAB is a relatively new bowel preparation on the market with very little published data on its known side effects. The convenience of a tablet formulation for a bowel preparation that achieves successful bowel cleansing attracts patients and doctors, but it comes with the cost of possible adverse side effects in the upper GI tract. The ingredients in SUTAB are corrosive agents, specifically, potassium chloride has been linked to erosions that are found in the mucosa of the GI tract with prolonged exposure. To better understand this recently noted phenomena, more research is needed to help prevent these unwanted and potentially dangerous side effects.

S2899 A Rare Case of Small Cell Lung Cancer in the Posterior Mediastinum Diagnosed With Endoscopic Ultrasound-Guided Fine Needle Biopsy

Introduction: Lung cancer is the leading cause of cancer mortality worldwide, accounting for 2 million diagnoses and 1.8 million deaths in 2020.1 10-15% of all lung cancers are small cell lung cancer (SCLC), an aggressive form that grows more rapidly and metastasizes more easily than NSCLC. Thus, in patients with suspected lung cancer, a tissue diagnosis is crucial. Here, we present a unique case of a man with a posterior mediastinal mass for whom obtaining a tissue diagnosis presented a diagnostic challenge. Case Description/Methods: A 49 y/o M, with a 30 pack-year smoking history, presented with worsening left-sided chest pain and a 10-pound unintentional weight loss over 2 months. Vital signs and physical exam were unremarkable. Labs demonstrated a mild anemia (Hb 11-12, MCV 82) and elevated inflammatory markers (ESR 54, CRP 70.9). CT scan demonstrated a 12.0x10.7x8.4 cm hypodense soft tissue density mass in the left posterior mediastinum, extending from the level of T1 to T7 vertebral bodies. The mass displaced the trachea, esophagus, and adjacent vessels. Several enlarged mediastinal lymph nodes were seen, the largest measuring up to 1.5 cm. However, there was no lymphadenopathy seen elsewhere and no convincing evidence of metastatic disease in the abdomen or pelvis. CT surgery recommended a CT-guided biopsy with IR vs. endoscopic bronchial US-guided biopsy. IR was unable to find a safe access point to go in for the biopsy as there was no window, as the lung was seen overlying the mass. The patient was discharged, and he returned the next week for outpatient EUS-FNB, which demonstrated a 72x39 mm mediastinal mass (Fig 1A). EUS-FNB was performed and EUS-guided transesophageal biopsies were performed. He was also found to have erosive gastritis, healing superficial sub-cm gastric ulcers, and multiple healing superficial duodenal ulcers. Pathology results demonstrated SCLC (Fig 1B-E) and H. pylori. He was treated with standard quadruple therapy, referred to his PCP to confirm eradication in 6 weeks, and referred to Oncology. For stage III-b SCLC treatment, he completed external beam RT and chemotherapy. Repeat PETCT demonstrated a decrease in the residual mass to 5.5x3.5x5.8 cm. Discussion: For patients presenting with a posterior mediastinal mass, for whom IR may not be able to perform a biopsy, obtaining a tissue diagnosis may be a diagnostic challenge. EUS-FNB provides a useful tool to assess the mediastinum and can provide timely diagnosis and staging of patients with rare forms of lung cancer.Figure 1.: A) A posterior mediastinal mass vs. esophageal mass measuring 72.1 mm by 39.2 mm was identified status-post EUS with FNB x 6. This mass appeared to arise from the muscularis propria of the esophagus; however, an extrinsic mediastinal mass could not be definitively ruled out due to the severe compressive effects of the mass on the esophagus. Mediastinal mass, needle biopsy: -Minute fragments of malignant neoplasm with necrosis. -Tumor cells are positive for AE1/3, CAM5.2, Chromogranin, Synaptophysin, CD56 and negative for p40, CD3, CD20, and CD45. Ki-67 demonstrats about 60% positivity. Combined with morphological features, this immunoprofile supports the diagnosis of small cell carcinoma. B) Hematoxylin and eosin (H&E) stain. C) CAM5.2. D) CD56. E) Chromogranin.

S3558 A Tale of Two Sisters: Two Pediatric Cases Within a Familial Cluster of Hereditary Diffuse Gastric Carcinoma

Introduction: We report a case of HDGC in two sisters, (10 and 15 years old) and their father (41 years old). Case Description/Methods: Our patient is a 15-year-old Caucasian female who initially presented to our clinic with a 4-month history of right lower quadrant tenderness and generalized abdominal pain, which she characterized as “stabbing pain.” Review of systems was significant for intermittent diarrhea and constipation. Family history was significant for a paternal great-aunt who reportedly died from gastric cancer at age 28. Abdominal ultrasound showed no significant abdominal pathology and no appreciable stomach wall thickening. EGD revealed diffuse mild inflammation of the stomach with normal appearing rugae without ulceration or masses and normal proximal duodenum. Biopsy results from the antrum revealed poorly differentiated signet ring cell carcinoma. The patient underwent a second EGD and imaging to confirm and stage the cancer. The patient subsequently underwent a laparoscopic roux-en-Y esophagojejunostomy, jejunojejunostomy with exploratory laparoscopy. Based upon the unusual occurrence of SRCC in a young female, the patient and her family underwent genetic testing. The patient was found to be positive for a CDH1/E-cadherin mutation. It was found that the patient’s father and her 10-year-old sister also carried this mutation. The 10-year-old sister and the father underwent screening EGD with greater than 40 biopsies taken throughout the stomach, esophagus, and duodenum in representative areas. Surprisingly, both patients were found also to have gastric SRCC. The father has since undergone chemotherapy, radiation, and a laparoscopic roux-en-Y esophagojejunostomy, jejunojejunostomy. The family is opting for conservative management at this time for the 10-year-old patient with plans to undergo the same surgery when she is older (Figure). Discussion: Gastric carcinoma in the pediatric population is exceedingly rare. HDGC should be considered when a patient presents with gastrointestinal symptoms and has a positive family history of gastric cancer among 1st and 2nd degree relatives, particularly if a relative was diagnosed before the age of 50. For carriers of the CDH1 mutation, prophylactic total gastrectomy is recommended with intraoperative confirmation of squamous epithelium in the esophagus at the proximal margin and duodenal mucosa at the distal margin. If gastrectomy is contraindicated, yearly endoscopic surveillance with random biopsies is recommended.Figure 1.: Biopsy from gastric antrum demonstrating poorly differentiated signet ring cell carcinoma present in the lamina propria.

S2541 A Rare Case of Erosive Gastritis and Melena Related to Gastric Mucosal Calcinosis

S2541 A Rare Case of Erosive Gastritis and Melena Related to Gastric Mucosal Calcinosis

S283 Increasing Time Interval Between Oral Sulfate Tablets for Bowel Preparation Reduces Incidence and Severity of Erosive Gastritis

S283 Increasing Time Interval Between Oral Sulfate Tablets for Bowel Preparation Reduces Incidence and Severity of Erosive Gastritis

S3398 Duodenal Follicular Lymphoma: Two Distinct Presentations of a Rare Disease Entity

Introduction: Follicular Lymphoma (FL), a B cell neoplasm, is the second most common type of nodal NHL with frequent duodenal involvement mostly presenting with non-specific abdominal pain. Primary Gastrointestinal Non-Hodgkin Lymphoma (PGINHL) is a rare entity accounting for 2% of all small intestinal malignancies. Duodenal Follicular Lymphoma (DFL) only accounts for 1 to 6% of PGINHL. We present two cases of DFL with variable symptoms. Case Description/Methods: Case 1: A 58-year-old female presented with nausea, vomiting, acid reflux, and 60-pound weight loss over one year. She denied any fever, night sweats, family history of malignancy and had a normal upper and lower endoscopy 5 years ago. EGD showed nodular mucosa in the 2nd portion of the duodenum confirmed to be low-grade FL on biopsy. Metastatic workup showed stage 4 lymphoma. There was no evidence of bulky lymphadenopathy and diagnosis of DFL was made. Patient finished 6 cycles of R-CHOP therapy due to concern for recurrent/residual DFL and currently remains indolent. Case 2: A 41-year-old male presented with coffee-ground emesis, melena, and 10 lbs weight loss over a month in absence of NSAID use. He also had fever, palpitations, and diaphoresis. Patient’s grandfather had colon cancer and the mother had non-Hodgkin lymphoma and breast cancer. EGD and colonoscopy 9 months prior to presentation showed erosive gastritis and tubular adenoma, respectively. Repeat EGD showed abnormal duodenal mucosa with an area of oozing at the site of the biopsy. Pathology report supported the diagnosis of low-grade DFL. Metastatic workup showed a mediastinal mass, a large 7.7 × 4.9 × 7 cm mesenteric nodal mass, and a 5.8 cm × 5.9 cm duodenal mass involving the head of the pancreas. The patient moved to Iowa for further workup (Figure). Discussion: DFL is an extremely rare PGINHL with an indolent course and good prognosis. DFL has unique features in that immunohistochemically it is similar to nodal FL, however, gene expression analysis groups it closer to MALT lymphoma, and thus, treatment options are heterogeneous with no established guidelines. ‘Wait and Watch’ strategy is often implemented in patients with low-grade disease, however, chemotherapy, radiation therapy, and immunotherapy have also been explored. Treatment of DFL with antibiotics owing to its similarity to and association with MALT lymphoma and H. pylori respectively has had mixed results. The two cases described above highlight heterogeneous presentation, dyspepsia, and upper GI bleed, of a rare malignancy - DFL.Figure 1.: The image on the left shows whitish nodular mucosa in the second portion of the duodenum in Case 1. The image on the right shows abnormal duodenal mucosa in Case 2.

S2675 Ischemic Gastropathy vs. Severe H. pylori Gastritis in a Patient With Extensive Vascular Disease

Introduction: Approximately half of gastric ulcers are associated with H. pylori. Conversely, gastric ulceration secondary to ischemia is rare due to the stomach’s abundant vascular supply from all three branches of the celiac artery. Here we present a case of a patient with upper gastrointestinal bleeding and concern for gastric ischemia who was diagnosed with H. pylori associated gastritis. Case Description/Methods: A 70-year-old female with severe peripheral artery disease, abdominal aortic aneurysm status post endovascular repair, hypertension, HIV, chronic kidney disease and B-cell lymphoma was admitted for pathologic right hip fracture and underwent open reduction and internal fixation. The procedure was complicated by lactic acidosis, an elevated troponin, and transaminitis in the setting of intraoperative hypotension. Six days later the patient had coffee ground emesis and melena with a lactate of 9.8 mmol/L and a hemoglobin of 6.4 g/dL, from 8.9 g/dL one day prior. 2 units of packed red blood cells were administered, anticoagulation was stopped, and a proton pump inhibitor was given. CT angiography of the abdomen and pelvis demonstrated splenic infarction, marked attenuation of multiple mesenteric vessels including the celiac artery, concern for ischemia of the stomach and cecum, and significant distention of the stomach (Figure A). Upper endoscopy demonstrated severe gastric mucosal pallor and decreased vascular pattern, diffuse linear erosions throughout the gastric fundus and body, and multiple large superficial ulcerations without active bleeding (Figure B and C). Given the appearance of the mucosa and overall clinical picture, there was concern for ischemic gastritis and biopsies were taken. Histology later revealed erosive gastritis, regenerative change and H. pylori without evidence of microthrombi or changes consistent with ischemia and the patient was started on quadruple therapy for H. pylori gastritis. She had one further episode of melena and received an additional blood transfusion before she was discharged one week later. Discussion: Our patient had extensive vascular disease and systemic hypotension with endoscopic findings highly suspicious for ischemic injury but with biopsies consistent with severe H. pylori gastritis. Although ischemic gastropathy should be considered in cases of an upper GI bleed in patients with vascular risk factors, careful histopathologic review is important for accurate diagnosis, and severe presentations of more routine diagnoses should also be considered.Figure 1.: A) CT angiography of the abdomen and pelvis demonstrating significant gastric distention. B) Esophagogastroduodenoscopy demonstrating mucosal pallor and C) large ulcerations within the gastric body.

Determine the Frequency of Different Causes CF Upper Gastrointestinal Bleed

Objective: To determine the frequency of various causes for upper gastrointestinal bleed. Study Design: Observational study. Place and Duration of Study: Department of Gastroenterology, Bolan Medical College Quetta from 1st July 2021 to 31st March 2022. Methodology: One hundred and thirty five patients in an age limit of >30 years were registered. The inclusion criteria were based on clinical diagnosis of GB of upper tract, blood tests included H-pylori conformational test as well as CBC. The first endoscopy was performed within the 48 hours initiation of bleeding. Results: The mean was 41.2±4.5 years. There were 68.8% males and 31.1% females. The main cause of gastrointestinal bleeding in cases was observed as varices and gastric ulcers highest within 40-60 years group while erosive gastritis and duodenal ulcers were presented most in males. Conclusion: The frequency of varices was 65.9% followed by 10.37% gastric ulcers presented in gastrointestinal bleeding of upper tract. Keywords: Gastrointestinal bleeding, Varices, Melena

Feasibility of olfactomedin 4 as a molecular biomarker for early diagnosis of gastric neoplasia after intestinal metaplasia

Objectives This study discusses whether olfactomedin 4 (OLFM4) could be used as a sensitive and specific biomarker in the early diagnosis of gastric cancer (GC) after gastric intestinal metaplasia (GIM). Methods An integrative analysis combining data derived from the Gene Expression Omnibus (GEO) and cBioPortal databases was performed to investigate the potential molecular biomarker. Immunohistochemistry and quantitative real-time polymerase chain reactions were used to measure the expression of messenger ribonucleic acid (mRNA) and protein by OLFM4. In combination with the gastroscopic findings and the OLFM4 expression in GIM-GC, a predictive model was established. The receiver operator characteristic curve (ROC) was applied to assess the diagnostic value of the model for GIM-GC. Results According to the GEO and cBioPortal databases, OLFM4 was identified as a key gene in the diagnosis of GIM-GC. Higher protein expression of OLFM4 was found in GIM and GIM-GC compared with chronic superficial gastritis (GS) (p < 0.05). The positive expression rate of OLFM4 in paracancerous tissue (GCP) was higher than in GIM (p > 0.05). There was no significant difference between GIM-GC and GCP (p > 0.05). The mRNA expression of OLFM4 was similar to the protein expression, and the positive expression rate was higher in early GIM-GC than in GIM (p < 0.05). Conclusion Olfactomedin 4 could be used as a biomarker for the early diagnosis of GIM-GC, and the logistic predictive model could be an effective tool for increasing the early diagnostic rate.

Study the role of oxidative stress in helicobacter pylori induced gastro-intestinal diseases

Background: Helicobacter pylori (H. pylori) is a multi-flagellated, spiral-shaped, Gram-negative, microaerophilic, slow-growing bacteria and extremely mobile which colonizes the stomach mucosa of a human where it causes a long-lasting infection which consistent with either acute or chronic stomach inflammation. Current study was aimed to evaluate total antioxidant capacity (TAC) and selenium (Se) levels in the serum of H. pylori infected individuals and to elucidate the relationship between the two biomarkers. Methods: Two study groups were enrolled in a current case control study; first group was included fifty five subjects with H. pylori infection which considered as H. pylori-associated patients (HPP), and the second group included thirty five apparently healthy subjects as healthy control (HC). Subjects were selected during the period between November 2021 and June 2022 after stringent application of the eligibility criteria. The HPP group subjects were underwent endoscopy and stool antigen test (SAT) and then both study groups subjects were evaluated for their serum anti-H. pylori antibodies (Abs), TAC and Se. Results: The findings revealed a significantly lower serum TAC and Se in HPP group in comparison with HC group. Serum immunoglobulin gamma (IgG) anti-H.

Indications and complications of balloon enteroscopy in Southwest of Iran: a 3years cross sectional survey

Introduction: The advent of capsule endoscopy (CE) and balloon-assisted Enteroscopy has changed the diagnosis and management of small intestine disorders over the past decade. The purpose of this evaluation is to review the findings of small intestine evaluation by Balloon Enteroscopy in Imam Hospital of Ahvaz between 2016 and 2019. Method: The present study is a descriptive epidemiological study that has been conducted using the files in the archives of Ahvaz Imam Hospital on a cross-sectional basis between 2016 and 2019 on all of the cases referred to this tertiary center to perform balloon Enteroscopy about their indications and any potential complication. A questionnaire containing several sections designed to collect the following data. Part A: (Basic Information) including age, sex, date and type of admission. Part B: (Record of previous diseases and procedures) including general health profile. Part C: (Enteroscopy Process Findings) and Part D: any potential complication. Results: Overall 42 procedures performed (29 male (69%) and 13 female (31%). The mean age of females (41.96y) was less than males (52.16y). The most common reasons for referring for Enteroscopy was Melena with unknown source (8 cases, 19%) and abdominal pain (6 cases, 14.3%). More than half of the patients (28 cases, 67%) were nonsmoker. The most common findings of Enteroscopy include peptic ulcer disease (PUD) (12 cases, 28.6%), hemorrhage from angiectasia (11 cases, 26.2%), erosive gastritis (9 cases, 21.4%) and small bowel stenosis and atrophy (7 cases, 16.7%). Among the complications after Enteroscopy, only abdominal pain was reported (2 cases, 4.76%). Conclusion: balloon Enteroscopy is a safe procedure and useful for evaluation of source of obscure bleedings and pain of unknown origin.

Liver cirrhosis with its complications: Case report in a young female patient

Liver cirrhosis is a chronic disease characterized by the presence of fibrosis and regeneration of nodules in the liver, the consequence of which is the development of portal hypertension and liver failure. Usually associated with infectious infectious diseases such as viral hepatitis, alcohol consumption, metabolic syndrome, autoimmune processes, storage diseases, toxic substances and drugs. Major complications include gastrointestinal variceal bleeding, ascites, spontaneous bacterial peritonitis infection, hepatorenal syndrome, hepatic encephalopathy, and hepatocellular carcinoma.&#x0D; A 23-year-old woman comes to the ER, dr. Soegiri Lamongan with complaints of vomiting blood. The patient also complained of black bloody stools. Referred patient from Intan Medika Hospital with the initial complaint of vomiting blood more than 5 times (± equivalent to one medium drinking bottle) four days ago. On examination also found anemic conjunctiva and found splenomegaly. On abdominal ultrasound examination, the liver was shrunken, the edges were obtuse angles, partially irregular, parenchymal echo intensity was heterogeneous, v.hepatica was normal, liver fibrosis staging was 11.81 kPa, no masses or nodules were seen. The conclusion on endoscopic examination was the presence of grade III esophageal varices, congestive gastropathy, and erosive gastritis.&#x0D; Liver cirrhosis is a disease that has various etiologies. Early diagnosis and appropriate treatment in cirrhotic patients with complications is one way to improve patient survival

Clinical Characteristics and Outcomes of Gastritis Associated With Immune Checkpoint Inhibitors: Scoping Review.

Among immune-related adverse events associated with immune checkpoint inhibitors, immune-mediated gastritis (IMG) has been rarely described in the literature and has not yet been well characterized. This scoping review aimed to characterize IMG in terms of precipitating agents, clinical presentations, and prognosis. After the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "immune checkpoint inhibitor," and "immune-related adverse event" from their inception to December 28, 2021. Twenty-two articles, including 5 observational studies and 17 case reports and case series, were included. Nivolumab, pembrolizumab, and combination therapy with those and cytotoxic T-lymphocyte-associated antigen-4 inhibitor (ipilimumab) were commonly used in those with IMG. 59.8% had epigastric pain, and 50% had erosive gastritis. 87.5% had Common Terminology Criteria for Adverse Events (CTCAE) grade 3 gastritis, and 91.2% received corticosteroids. Recurrence was noted in 16.7%, and only 1 expiration was noted. 4.3% had positive helicobacter pylori and cytomegalovirus from the gastric specimen. Similar to immune-related colitis, patients with IMG may have a favorable prognosis with a better response to immune checkpoint inhibitors if treated appropriately. The diagnosis of IMG is made by exclusion, and a thorough workup is necessary to rule out concurrent helicobacter pylori and cytomegalovirus involvement. Further studies are critical for a better understanding of this complication.

S285: INHIBITION OF COMPLEMENT C1S WITH SUTIMLIMAB IN PATIENTS WITH COLD AGGLUTININ DISEASE (CAD): 2-YEAR FOLLOW-UP FROM THE CARDINAL STUDY

Background: CAD is a rare chronic autoimmune hemolytic anemia characterized by classical complement pathway (CP)-mediated hemolysis. Sutimlimab is a first-in-class humanized monoclonal antibody that selectively inhibits C1s of the C1 complex, preventing CP activation, while leaving the alternative and lectin pathways intact. One-year interim follow-up from the CARDINAL study (NCT03347396) have previously demonstrated that sutimlimab resulted in sustained improvements in hemolytic markers and quality of life. Aims: To report 2-year sutimlimab efficacy and safety from the CARDINAL Part B extension. Methods: CARDINAL was a Phase 3, open-label, single-arm study with a 26-week treatment period (Part A) and a 2-year extension (Part B) after the last patient (pt) finishes Part A. Sutimlimab was administered through intravenous infusions on Days 0 and 7, followed by biweekly dosing. Efficacy data through Week 131, the last data recording within the 2-year Part B period, are reported here. Efficacy endpoints included change from baseline in hemolytic markers, pharmacodynamic (PD) markers and blood transfusions. Quality of life (QOL) was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale. Safety was recorded until end-of-study visit 9 weeks after their last dose; endpoints included incidence of treatment-emergent adverse event (TEAE) and serious TEAE (TESAE). Descriptive statistics, frequency, and percentage were used to analyze outcomes. Results: Of the 24 pts enrolled in Part A, 22 completed Part A and entered Part B, with 19 (86.4%) pts completing Part B. Sutimlimab treatment improved mean (SD) hemoglobin (Hb) levels within one week; mean Hb remained >11 g/dL from Week 5–131 (baseline: 8.64 (1.67) (Figure). Mean total bilirubin was normalized from Week 3–131 (Figure). Mean FACIT-Fatigue scores improved within 1 week and remained ≥5 from Week 1–123 (Figure), consistent with a clinically meaningful change. Improvements in Hb, bilirubin, and FACIT-Fatigue correlated with normalization of C4 and near-complete inhibition of CP activity. Normalization of mean absolute reticulocyte count was observed alongside normalized haptoglobin levels and reductions in LDH. From Week 26–131, 15 (68.2%) pts remained transfusion-independent. All 22 pts experienced ≥1 TEAE; 12 (54.5%) pts experienced ≥1 TESAE. Serious infections were reported in 7 (31.8%) pts, including one pt with sepsis due to streptococcus pneumoniae. No meningococcal infections were reported. Three pts discontinued the study due to AEs (cyanosis and klebsiella pneumoniae (n=1); vitreous hemorrhage (n=1); cyanosis and gastrointestinal symptoms including erosive gastritis (n=1)). No pts developed systemic lupus erythematosus, serious hypersensitivity or anaphylaxis. Two pts died during the study (klebsiella pneumoniae (n=1); exacerbation of CAD (n=1) in a patient with a femoral neck fracture and complex medical history including myelodysplastic syndrome, approximately 1.5 months after receiving the last dose of sutimlimab). Image:Summary/Conclusion: Sutimlimab, a first-in-class selective anti-C1s classical complement pathway inhibitor, maintained mean Hb levels >11g/dL, achieved sustained normalization of mean bilirubin, haptoglobin and reticulocyte count. Sutimlimab continued to improve FACIT-Fatigue scores, with no newly identified safety concerns at 2 years of treatment. This study has demonstrated that sutimlimab is an effective and well-tolerated long-term therapy for the management of chronic CAD through continued upstream inhibition of the classical CP.

Prevalence of Autoimmune-phenomena behind Chronic Gastritis of Unknown Origin, and their Role in the Poor Histological Outcome of the Stomach: A Single-centre, Retrospective Cross-sectional Study.

The underlying aetiology of chronic gastritis (CG) often remains unknown due to its underrated significance in clinical practice. However, the role of chronic inflammation of the stomach in the development of atrophy, intestinal metaplasia (IM) and eventually of gastric cancer is well documented. We aimed to explore the possible aetiological factors of CG, determine the prevalence of systemic autoimmune disorders in patients with CG of unknown aetiology, and clarify the role of autoantibodies in the development of precancerous lesions in the stomach. This is a retrospective, cross-sectional study, conducted from January 2016 to January 2020, including data from 175 patients with CG. Exclusion criteria were: (1) acute gastritis; (2) reactive gastropathy; (3) gastric cancer; (4) subjects without any serology testing results; and (5) Helicobacter pylori positivity. The primary endpoint was a composite endpoint involving gastric atrophy and IM. Fifty-five per cent of patients with CG had autoantibodies. Systemic lupus erythematosus (SLE)-related antibodies were positive in most of the cases, including antinuclear antibody (ANA) positivity, which was found in 19.13% of the patients. Autoimmune positivity was shown to be associated with precancerous lesions in the stomach (p<0.001): IM, atrophy and IM with atrophy. Anti-parietal cell antibody positivity seems to be a significant risk factor for IM and IM with atrophy. Autoimmune thyroiditis-related antibodies and ANA positivity by itself were only associated with atrophy; SLE-related antibodies and inflammatory bowel diseases related antibodies (ASCA and ANCA) correlated either with IM or with atrophy. No significant relation was found between any other investigated autoimmune disease-related antibodies and precancerous lesions. Autoimmune positivity often underlies gastritis of unknown aetiology and predisposes to precancerous lesions in the stomach. These antibodies can serve as non-invasive markers for the of optimal timing of an endoscopic follow-up strategy. Furthermore, CG can be an early symptom of a systemic autoimmune disorder.